São Paulo, Brazil
São Paulo, Brazil

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Ferreira F.R.,University of Taubaté | Nascimento L.F.C.,University of Sao Paulo | Rotta O.,UNIFESP EPM
Revista da Associacao Medica Brasileira | Year: 2011

Objective: To identify factors associated with non-melanoma skin cancer in the city of Taubaté, São Paulo, Brazil. Methods: Hospital-based case-control study with individuals residing in Taubaté, treated between January 2005 and December 2006. The subjects were matched 1:1 according to gender and age. Age, gender, phototype, European descent, time of residence, sun exposure, time (in years), number of hours and time of occupational and non-occupational sun exposure, photoprotection, family history and photodamage were independent variables. A hierarchical logistic regression was used at three levels. The model adjustment was performed using the Hosmer-Lemeshow test and its accuracy was verified by ROC curve. The significance level was p<0.05. Results: There were 132 cases and 132 controls. Phototype with OR=3.14 (95%CI 1.79-5.49), hours of occupational 1.76 (1.04-2.99) and non-occupational sun exposure 1.80 (0.98-3.29) and family history 2.10 (1.13-3.93) were the variables in the final model. Hosmer-Lemeshow test, p=0.97. Accuracy 70% (95%CI 63-76). Conclusion: We concluded that fair skin, family history and occupational and non-occupational sun exposure were associated with non-melanoma skin cancer in Taubaté-São Paulo. © 2011 Elsevier Editora Ltda.


Bianca A.D.,UNIFESP EPM | Wandalsen G.,UNIFESP EPM | Mallol J.,University of Chile | Sole D.,UNIFESP EPM
Journal of Tropical Pediatrics | Year: 2012

The objective of this study was to identify risk factors for wheezing disorders in the first year of life in infants living in São Paulo (SP), Brazil, applying the standardized protocol of the Estudio Internacional de sibilancia en lactentes-Phase 1. A total of 1014 parents or caregivers of infants, who attended for routine evaluation and immunization in public health centers were interviewed in Southern SP city. Risk factors significantly associated with recurrent wheezing were: history of previous pneumonia, daycare attendance, consumption of processed food, presence of a cat at home, more than five upper respiratory infection (URI) episodes and the first URI before the age of sixth month. Most of these risk factors for wheezing can be avoided or controlled. Prospective studies on wheezing, especially in children with a severe presentation, are needed to analyze the impact of these risk factors and the effect of preventive actions. © The Author [2012]. Published by Oxford University Press. All rights reserved.


Pires Santos F.,UNIFESP EPM | Weber R.,ENT Clinic of the Professor Edmundo Vasconcelos Hospital | Callegaro Fortes B.,ENT Clinic of the Professor Edmundo Vasconcelos Hospital | Nagata Pignatari S.S.,UNIFESP EPM
Brazilian Journal of Otorhinolaryngology | Year: 2013

Send correspondence to: Bibiana Callegaro Fortes. Rua Borges Lagoa, no 1450, 3o andar do prédio de ambulatórios. Vila Clementino. São Paulo - SP. Brazil. CEP: 04038-905. Paper submitted to the BJORL-SGP (Publishing Management System - Brazilian Journal of Otorhinolaryngology) on April 14, 2012; and accepted on October 13, 2012. cod. 9153. Palatine and pharyngeal tonsils are immune reactive lymphoid organs that manifest specific antibodies and B/T-cell activity to respond to a variety of antigens. They perform humoral and cellular immune functions. The possible effects of adenotonsillectomy upon the immune system remain controversial. Objective: To study the short and long-term impacts of tonsillectomy upon the cellular and humoral immunity of children. Method: This longitudinal prospective study included 29 children referred to adenotonsillectomy for adenotonsillar hypertrophy. Serum IgA, IgM, and IgG and lymphocyte counts were analyzed at three points in time: before surgery, 1-2 months after surgery (short term), and 12-14 months after surgery (long term). Results: TCD4+ cell counts were significantly increased shortly after surgery. IgA and IgG values were significantly reduced in the long run, but were within normal ranges for this age group. Conclusion: This study indicated that adenotonsillectomy does not pose negative short or long term impacts upon the cellular and humoral immunity of children submitted to the procedure.


Reis L.A.,UNIFESP EPM | Borges F.T.,UNIFESP EPM | Simoes M.J.,UNIFESP EPM | Borges A.A.,Electronic Microscopy Center | And 2 more authors.
PLoS ONE | Year: 2012

This study evaluated the effects of bone marrow-derived mesenchymal stem cells (BMSCs) or their conditioned medium (CM) on the repair and prevention of Acute Kidney Injury (AKI) induced by gentamicin (G). Animals received daily injections of G up to 20 days. On the 10th day, injections of BMSCs, CM, CM+trypsin, CM+RNase or exosome-like microvesicles extracted from the CM were administered. In the prevention groups, the animals received the BMSCs 24 h before or on the 5th day of G treatment. Creatinine (Cr), urea (U), FENa and cytokines were quantified. The kidneys were evaluated using hematoxylin/eosin staining and immunohystochemistry. The levels of Cr, U and FENa increased during all the periods of G treatment. The BMSC transplantation, its CM or exosome injections inhibited the increase in Cr, U, FENa, necrosis, apoptosis and also increased cell proliferation. The pro-inflammatory cytokines decreased while the anti-inflammatory cytokines increased compared to G. When the CM or its exosomes were incubated with RNase (but not trypsin), these effects were blunted. The Y chromosome was not observed in the 24-h prevention group, but it persisted in the kidney for all of the periods analyzed, suggesting that the injury is necessary for the docking and maintenance of BMSCs in the kidney. In conclusion, the BMSCs and CM minimized the G-induced renal damage through paracrine effects, most likely through the RNA carried by the exosome-like microvesicles. The use of the CM from BMSCs can be a potential therapeutic tool for this type of nephrotoxicity, allowing for the avoidance of cell transplantations. © 2012 Reis et al.


Perazzio S.F.,UNIFESP EPM | Salomao R.,Immunology and Virology Laboratory | Silva N.P.,UNIFESP EPM | Andrade L.E.C.,UNIFESP EPM | Andrade L.E.C.,Fleury Medicine and Health Laboratories
Lupus | Year: 2012

Introduction: There is increased frequency of discoid lesions (2.7%) and SLE (0.5%) in patients with chronic granulomatosus disease, but the literature is still controversial about phagocyte oxidative burst in SLE patients. Materials and methods: 300 SLE patients and 301 blood donors were evaluated for quantitation of the oxidative burst in phagocytes by flow cytometry based on the oxidation of 2,7-dichlorofluorescein-diacetate after stimuli with Staphylococcus aureus and Pseudomonas aeruginosa. Results: Neutrophils from SLE patients displayed higher basal reactive oxygen species (ROS) production than healthy controls [Mean of fluorescence intensity (MFI) = 53.77 ± 11.38 vs 15.08 ± 2.63, p < 0.001] and after stimulation with S. aureus (MFI = 355.46 ± 58.55 vs 151.92 ± 28.25, p < 0.001) or P. aeruginosa (MFI = 82.53 ± 10.1 vs 48.99 ± 6.74, p < 0.001). There was stronger neutrophil response after bacterial stimuli (ΔMFI) in SLE patients than in healthy controls (S. aureus = 301.69 ± 54.42 vs 118.38 ± 26.03, p < 0.001; P. aeruginosa = 28.76 ± 12.3 vs 15.45 ± 5.15, p < 0.001), but no difference with respect to the oxidative burst profile according to disease activity (SLEDAI ≥ 6) or severity (SLICC-DI ≥2). Patients with kidney involvement presented higher basal and stimulated ROS production in neutrophils. Discussion: The present findings corroborate the important role of innate immunity in SLE and implicate neutrophils in the pathophysiology of the disease. © 2012 The Author(s).


Bocalini D.S.,Unifesp EPM | Serra A.J.,Unifesp EPM | Dos Santos L.,Incor
Journal of Aging Research | Year: 2010

Twenty five subjects were randomized to untrained (UN) and resistive-trained (RT) groups. The RT group exercised three sessions per week at 60-70 of the load according to individual 1RM test during 24 weeks. Both groups were evaluated before and after protocol period assessing lumbar spine (LS) and femoral neck (FN) BMD by dual-energy X-ray absorptiometry, VO 2 max, and neuromuscular fitness. After 24 weeks, there were significant reductions in LS (0.89±0.16 loss) and FN BMD (1.54±0.35 loss) for UN but no change was found in the TR (LS: 0.01±0.12 and FN: 0.04±0.05 loss). The UN group had no changes in neuromuscular performance. However, RT exhibited a significant improvement on the functional fitness parameters evaluated, with the exception of agility. Our results indicate RT suppresses the decline in BMD and simultaneously improves the functional fitness of postmenopausal women without hormone replacement therapy, which may reduce fall risk and related bone fractures. Copyright © 2010 Danilo Sales Bocalini et al.


Weiler F.G.,Federal University of São Paulo | Dias-da-Silva M.R.,Unifesp EPM | Lazaretti-Castro M.,Federal University of São Paulo
Arquivos Brasileiros de Endocrinologia e Metabologia | Year: 2012

Autoimmune polyendocrine syndrome type 1 (APECED) is a rare autosomal recessive disorder characterized by autoimmune multiorgan attack. The disease is caused by mutations in the autoimmune regulator gene (AIRE), resulting in defective AIRE protein, which is essential for selftolerance. Clinical manifestations are widely variable. Although the classic triad is composed by mucocutaneous candidiasis, hypoparathyroidism and adrenal failure, many other components may develop. Treatment is based on supplementation of the various deficiencies, and patients require regular follow-up throughout their lifespan. This article describes the case of a patient with the disease, and reviews literature data on the epidemiology, clinical course, immunogenetic aspects, diagnosis and treatment of the syndrome.


Do Amaral M.I.R.,University of Campinas | Colella-Santos M.F.,UNIFESP EPM | Colella-Santos M.F.,University of Campinas
Brazilian Journal of Otorhinolaryngology | Year: 2010

Time resolution hearing skill is the minimum time necessary to solve acoustic events, which is fundamental for speech understanding, and which may be assessed by gap-detection tests, such as the Gaps-in-noise test (GIN). Aim: the purpose of this study was to verify the performance of time processing ability in children with no hearing and/or education difficulties by applying the GIN test in both genders and ages from 8 to 10 years. Study design: a prospective cross-sectional contemporary cohort. Material and method: The GIN test was applied to 75 school-aged children separated into three groups by age. Results: The findings showed no statistical differences among age groups or ears. Males had slightly better responses than females on the percentage of correct responses only. Conclusion: The gap threshold and percentage of correct responses were calculated regardless of the ear, gender or age, and were respectively 4.7ms and 73.6%. Based on a 95% confidence interval, the cut-off criterion for normal and abnormal performance was 6.1ms for the mean gap detection threshold and 60% for the percentage of correct responses.


da Silva A.F.,UNIFESP EPM | Silva K.,UNIFESP EPM | Reis L.A.,UNIFESP EPM | Teixeira V.P.C.,UNIFESP EPM | Schor N.,UNIFESP EPM
Cell Transplantation | Year: 2015

The therapeutic potential of mesenchymal stem cells (MSCs) and their conditioned medium (MSC-CM) has been extensively studied. MSCs can repair tissue, reduce local inflammation, and modulate the immune response. Persistent renal tubular interstitial inflammation results in fibrosis and leads to chronic kidney disease (CKD). Unilateral ureteral obstruction (UUO) is a very well-accepted renal fibrosis model. In this study, we evaluated factors influenced by the administration of MSCs or MSC-CM in the UUO model. MSCs extracted from rat bone marrow were cultivated in vitro and characterized by flow cytometry and cellular differentiation. Eight groups of female rats were used in experiments (n = 7, each), including Sham, UUO, UUO + MSC (obstruction + MSC), and UUO + CM (obstruction + MSC-CM) for 7 days of obstruction and Sham, UUO, UUO + MSC, and UUO + CM for 14 days of obstruction. The MSCs or MSC-CM was administered via the abdominal vena cava after total ligation of the left ureter. After 7 or 14 days, rats were euthanized, and serum and obstructed kidney samples were collected. MSCs or MSC-CM decreased the expression of molecules, such as Col1a1, α-SMA, and TNF-α. We also observed reductions in the levels of caspase 3, α-SMA, and PCNA in treated animals by immunohistochemistry. Our results suggest that the intravenous administration of MSCs or MSC-CM improves fibrosis progression and factors involved in apoptosis, inflammation, cell proliferation, and epithelial–mesenchymal transition in Wistar rats subjected to UUO, indicating a potential tool for preventing CKD. © 2015 Cognizant Comm. Corp.


Gregorio L.L.,UNIFESP EPM | Andrade J.S.C.,UNIFESP EPM | Caparroz F.A.,UNIFESP EPM | Saraceni Neto P.,UNIFESP EPM | Kosugi E.M.,UNIFESP EPM
Clinical Otolaryngology | Year: 2015

Objectives: Sino Nasal Outcome Test (SNOT)-22 is a disease-specific outcomes measure questionnaire that combines rhinologic issues with general health issues. These issues may have variable weight on quality of life perception, and the influence of several factors such as gender, ethnicity, age, socio-cultural status and co-morbidities is unknown. The aim of this study was to evaluate the influence of gender and age on normal values of SNOT-22. Design: Cross-sectional study based on application of SNOT-22 questionnaires to healthy volunteers. Participants were divided according to gender, and each gender was subdivided into age groups: 18-30 years, 31-40 years, 41-50 years, 51-60 years and over 60 years. Setting: Rhinology Section, Sao Paulo Federal University. Participants: A total of 539 healthy volunteers (253 men and 286 women) were selected, so that each age group of each gender consisted of at least 50 individuals. Main outcomes measures: We applied SNOT-22 questionnaire to volunteers with no nasal or sinus disease. Median of score distribution was used as normal reference. Results: Men presented lower scores than women (7 versus 9, P = 0.005). Subjects over 60 years presented significantly lower scores than other age groups (18-30 years = 10; 31-40 years = 8; 41-50 years = 9; 51-60 years = 9; over 60 years = 7). Men presented lower scores than women especially in 41-50 year and 51-60 year groups. Conclusion: Men and elderly presented the lowest Brazilian version SNOT-22 scores. The range of 0-8 points seemed to be more suitable as a normal value for this instrument, but this cut-off score could be tailored to age and gender specificities. © 2014 John Wiley & Sons Ltd.

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